CT Colonography Cost-Effective, Clinically Effective for CRC Screening
MONDAY, June 16, 2025 -- Computed tomography colonography (CTC) is cost-effective and clinically effective for colorectal cancer (CRC) screening, according to a study published online June 10 in Radiology.
Perry J. Pickhardt, M.D., from the University of Wisconsin School of Medicine & Public Health in Madison, and colleagues compared the clinical efficacy and cost-effectiveness of CRC screening with CTC versus multitarget stool DNA (mt-sDNA) testing. Using updated natural history evidence for colorectal polyps applied to a hypothetical 10,000-person cohort representative of the 45-year-old U.S. population, a Markov model was constructed. Three screening strategies were modeled with these data: mt-sDNA testing every three years, conventional CTC (CTCconv), and surveillance CTC (CTCsurv) strategies. The CTCconv strategy involved immediate polypectomy for all polyps measuring at least 6 mm every five years, whereas the CTCsurv strategy involved three-year CTC follow-up for small polyps measuring 6 to 9 mm and polypectomy for polyps ≥10 mm.
The researchers found that the cumulative incidence of CRC was 7.5 percent without screening, which was reduced by 59, 75, and 70 percent with mt-sDNA, CTCconv, and CTCsurv, respectively. The estimated programmatic costs were $4,955, $6,011, $4,422, and $3,913 for no screening, mt-sDNA, CTCconv, and CTCsurv, respectively. Per quality-adjusted life-year (QALY) gained, the estimated cost was $8,878 for mt-sDNA, while both CTC strategies were cost-saving; consequently, CTC strategies dominated over mt-sDNA and no screening. The CTCconv strategy was less cost-effective than the CTCsurv strategy, with costs associated with more optical colonoscopies not offsetting the small gains in QALYs. When CRC screening began at ages 50 and 65 years, the results were similar.
"Among the safe, minimally invasive colorectal cancer screening options, CT colonography is more effective at preventing and detecting cancer -- and is also more cost-effective -- than stool DNA testing," Pickhardt said in a statement.
Several authors disclosed ties to the biotechnology and medical technology industries, including Bracco Diagnostics, which partially funded the study.
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